Tuesday, September 20, 2016

Mesenteric Ischemia

EM Didactic - September 19, 2016 - By Lakshay Chanan
"Mesenteric ischemia (MI) is a frightful pathology due to its variable presentations, time‐ sensitive nature, and high morbidity and mortality. It is quite a rare disease; and as Emergency Physicians we are likely to encounter only a few cases of it in our entire careers. As a consequence of that, it gives a hard time to even the most senior physicians to diagnose mesenteric ischemia. Ischemic bowel can progress to infarction within a matter of hours which gives us a very short window to make the diagnosis. Moreover, Emergency Physicians may be the only early healthcare providers who see these patients within such a narrow time‐frame, which makes it pivotal for us to know about this entity
Lets look at some key questions regarding Mesenteric Ischemia...
Key Points:
  • Whenever you suspect Mesenteric Ischemia, do not dilly-dally – Do a quick assessment and come up with a plan. Get senior help early enough. Involve your Surgical colleagues and Radiologists ASAP.
  • Start suspecting MI despite normal vital signs and laboratory values. Do not overly on White cell count and lactate. Remember, Nothing is 100% in Medicine!
  • X-rays and CT with oral contrast rarely provide any useful information. Use CT with IV contrast in those patients with normal renal function to pick vascular filling defects."